The Population Health Specialist II provides operational support for the Case, Condition Management, Quality, Wellness, Pharmacy, Government Relations, and Utilization Management Departments including requesting and extracting medical records and provider outreach for HEDIS, Health Risk Assessments, Primary Care Provider Attributions, and CIOX medical records. This role assists with supporting and monitoring compliance with CMS federal regulatory...
Network Health’s success is deeply rooted in its mission to build healthy and strong Wisconsin communities. This mission shapes every decision we make, including the selection of individuals who join our growing team. The. Member Experience Representative I. will support our various line of business by addressing benefit interpretations, claims, authorizations, and other member inquiries in a collaborative and innovative environment. This role in...
The Quality Care Coordinator develops, implements and provides ongoing monitoring of intervention plans and quality gap closure. The overall goal of this role is to reduce medical costs and improve quality ratings. The Quality Care coordinator achieves this goal through member and/or provider engagement, internal quality process improvement work, and coordination of overall clinical intervention strategies. The Quality Care Coordinator conducts H...
The Pharmacist Utilization Management oversees the administration of the pharmacy department’s utilization management program for both traditional pharmacy and infusion-related medications. This individual provides clinical support for other departments quality and health management efforts. This role assists in the development and evaluation of the plan formulary and benefit designs. Location. Candidates must reside in the state of Wisconsin for...
The Systems Administrator I is responsible for providing support for a variety of systems & network equipment. They will assist in the installation and configuration computer equipment, create technical support documentation for systems and applications, maintain the environment by identifying system requirements, installing upgrades, monitoring system performance & asset management. The individual will need to be familiar with Microsoft Server &...
At Network Health, our success is driven by our mission to build healthy, strong Wisconsin communities. This mission inspires every decision we make, including the exceptional individuals we welcome to our team. We are currently seeking a. Receptionist. to join our Brookfield office. Responsibilities. As the first point of contact for our members and visitors, the Receptionist will embody professionalism and a commitment to service excellence. Th...
The Population Health Specialist II provides operational support for the Case, Condition Management, Quality, Wellness, Pharmacy, Government Relations, and Utilization Management Departments including requesting and extracting medical records and provider outreach for HEDIS, Health Risk Assessments, Primary Care Provider Attributions, and CIOX medical records. This role assists with supporting and monitoring compliance with CMS federal regulatory...
The ETL Developer I is part of a team dedicated to supporting Network Health’s core claims processing system, related data integrations, vendor extracts and reporting. This individual will perform detailed interface design and development, program, analysis, coding, testing, debugging, documentation, implementation of interfaces and reports, development, and maintenance of data feeds for Network Health. Location. Candidates must reside in the sta...
The Data Warehouse Engineer I is part of a team dedicated to supporting Network Health’s Enterprise Data Warehouse. This individual will perform development, analysis, testing, debugging, documentation, implementation, and maintenance of interfaces to support the Enterprise Data Warehouse and related applications. They will consult with other technical resources and key departmental users on solutions and best practices. They will monitor perform...
Network Health’s success is rooted in its mission to create healthy and strong Wisconsin communities. This mission drives the decisions we make, including the people we choose to join our growing team. Responsibilities. We are seeking a. Claims Analyst II. to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established policies and procedures. Key res...
The Registered Nurse Care Manager provides case management services that are member-centric and include assessment, planning, facilitation, care coordination, evaluation and advocacy to all members across the healthcare continuum. The Care Manager advocates for options and services to meet an individual’s and family’s comprehensive health needs through communication and coordination of available resources to promote quality, cost-effective outcom...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable guidelines regarding payment and coverage, and makes determinations for authorization/payment. Location. Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). ...
